Documente Academic
Documente Profesional
Documente Cultură
Communicable Disease
Control
Mulugeta Alemayehu
Hawassa University
In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center,
the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education
2004
This material is intended for educational use only by practicing health care workers or
students and faculty in a health care field.
Preface
This lecture note was written because there is currently no
uniformity in the syllabus and, for this course additionally,
available textbooks and reference materials for health
students are scarce at this level and the depth of coverage in
the area of communicable diseases and control in the higher
learning health institutions in Ethiopia. The author hopes that
the material will, to some extent, solve this problem. Although,
this lecture note is prepared and intended for use primarily for
nursing students, other health science students and health
professionals can use it. After using this material, students are
expected to be able to:
to
address
all
the
topics
mentioned
in
the
clinical
manifestation,
diagnostic
criteria,
ii
Acknowledgments
I am highly indebted to acknowledge The Carter Center Ethiopia Public Health Training Initiative (EPHTI), Addis
Ababa, for its magnificent contribution in the preparation of
this useful lecture note in terms of logistics and administrative
support. I am also indebted to my students, to whom I owe
much
of
what
have
learned
about
teaching
the
iii
Table of Contents
Preface
Acknowledgement
iii
Table of Contents
iv
List of Figures
ix
Diseases in Ethiopia
1.3 Epidemiological Terms and Definitions
Review Questions
4
7
15
15
16
19
Review Questions
22
iv
23
DISEASES
3.1 Learning Objectives
23
3.2 Introduction
23
24
42
56
Review Questions
61
62
62
4.2 Introduction
62
63
4.4 Measles
65
4.5 Influenza
68
4.6 Diphtheria
70
4.7 Pertusis
73
76
79
4.10 Tuberculosis
81
4.11 Leprosy
87
Review Questions
91
92
92
5.2 Introduction
92
93
5.4
Flea-borne Diseases
106
5.5
Louse-borne Diseases
111
5.6
Snail-borne Diseases
116
Review Questions
126
122
DISEASES
6.1
Learning Objectives
127
6.2
Introduction
127
6.3
Syphilis
129
6.4
Chancroid
133
6.5
Lymphogranuloma Venereum
135
6.6
Herpes Genitalia
137
6.7
Candidiasis
139
6.8
Gonorrhea
141
6.9
Trichomoniasis
143
6.10 HIV/AIDS
146
Review Questions
150
151
7.1
Learning Objectives
151
7.2
Introduction
151
7.3
Food of Animals
152
7.4
169
vi
7.5
172
7.6
177
Review Questions
187
188
8.1
Learning Objectives
188
8.2
Introduction
188
8.3
189
8.4
Botulism
192
8.5
Salmonellosis
195
Review Questions
198
199
Learning Objectives
199
Review Questions
205
Glossary
206
References
211
vii
List of Figures
Fig. 3.1 The five Fs which play an important role in
fecal-oral diseases transmission
Fig. 3.2 Transmission and life cycle of Entameoba
histolytica
Fig. 3.3 Transmission and life cycle of Giardia lamblia
Fig. 3.4 Transmission and life cycle of Ascaris
lumbricoids
Fig. 3.5 Transmission and life cycle of Trichuris
trichuria
Fig. 3.6 Transmission and life cycle of Entrobius
Vemicularis
Fig. 3.7 Transmission and life cycle of Strongyloides
Stercolaris
Fig. 3.8 Transmission and life cycle of Hookworms
Fig. 5.1 Transmission and life cycle of Malaria
parasites
Fig. 5.2 Transmission and life cycle of W. bancrofti
and Brugia species
Fig. 5.3 Transmission and life cycle of Schistosoma
species
Fig. 7.1 Transmission and life cycle of Taenia solium
and Taenia saginata
Fig. 7.2 Transmission and life cycle of Leishmania
parasites
Fig. 7.3 Transmission and life cycle of T.b.
rhodesiense and T.b. gambiense
viii
24
33
36
44
47
50
52
54
96
100
119
154
179
183
AIDS
BCG
Bacillus of Calmate-Guirein
Bid
B. Sc.
Degree Celsius
CNS
CSF
Cerebro-spinal fluid
CT
Computerized Tomography
DEC
Diethylcarbamazin Citrate
DOTS
GIT
Gastro-intestinal Tract
HIV
IgM
Immunogloblin M.
IM
Intramuscular
IU
International Unit
IV
Intravenous
Kg
Kilogram
MOH
Ministry of Health
MRI
OPV
PO
PTB
QID
ix
STD
STI
TB
Tuberculosis
Tid
URTI
USA
WHO
CHAPTER ONE
INTRODUCTION
1.1
Learning Objectives
Diseases
can
be
classified
according
to
two
major
organisms.
These
are
called
communicable
diseases,
Immunization
Anti-microbial chemotherapy
Improved nutrition
Nutritional problems
Helminthiasis (6.7%)
Bronchopneumonia (5.5%)
Dysentery (3.5%)
Pneumonia (8.9%)
Meningitis (0.9%)
Pneumonia (7.3%)
Meningitis (1.5%)
AIDS (0.8%)
Leishmaniasis (0.5%)
cause
of
blindness
in
Ethiopia),
and
1.3
"Determinants
These
are
factors
that
determine
Review Questions
1. How do you compare the impact of communicable
disease in Ethiopia with that of the developed world?
2. What are some of communicable diseases that create
major health problems in Ethiopia?
3. Define the following terms:
-
Epidemiology
Epidemics
Endemic
Pandemic
Sporadic
CHAPTER TWO
DEFINITION, DESCRIPTION OF THE
TRANSMISSION, PREVENTION AND
CONTROL OF COMMUNICABLE
DISEASES
2.1
Learning Objectives
Describe
the
factors
involved
in
the
chain
of
2.2
Communicable Diseases
2.3
c. Portal of exit
d. Mode of transmission
e. Portal of entry
f. Susceptible host
a.
Bacteria
(e.g.
tuberculosis, etc.)
Anthrax
Rabies
Human
10
GIT:
typhoid
fever,
bacillary
dysentery,
amoebic
11
a. Direct Vertical
Such as: transplacental transmission of syphilis, HIV, etc.
b. Direct horizontal
Direct touching, biting, kissing, sexual intercourse, droplet
spread onto the conjunctiva or onto mucus membrane of
eye, nose or mouth during sneezing coughing, spitting or
talking; Usually limited to a distance of about one meter or
less.
2. Indirect transmission
a.
12
Dust:
Mucus membrane
Skin
Respiratory tract
13
GIT
Blood
Specific factors
14
15
communicable
disease
(infectious
agent)
is
16
an
infection.
Active
immunization
means
17
18
19
High infectivity
20
2. Interruption of transmission
This involves the control of the modes of transmission from
the reservoir to the potential new host through:
Control of vectors
Chemo-prophylaxis-
(e.g.
Malaria,
meningococcal
meningitis, etc.)
Better nutrition
21
Review Questions
1. State the six important factors that involve the chain of
communicable diseases transmission.
2. Describe the three levels of disease prevention.
3. What are the methods used to control communicable
diseases?
22
CHAPTER THREE
ORAL-FECAL TRANSMITTED
DISEASES
3.1 Learning Objectives
At the end of this chapter, students will be able to:
3.2 Introduction
What the diseases in this group have in common is that the
causative organisms are excreted in the stools of infected
persons (or, rarely, animals). The portal of entry for these
diseases is the mouth.
23
Soil
Food
Mouth
Flies
Finger
Fig. 3.1 The five Fs which play an important role in fecal oral diseases
transmission
(finger,
flies,
food,
fomites
and
fluid).
(From
Eshuis,
24
systemic
infectious
disease
characterized
by
high
25
usually
convalescence.
from
About
the
10%
first
of
week
untreated
throughout
patients
will
Clinical manifestation
First week- Mild illness characterized by fever rising stepwise
(ladder type), anorexia, lethargy, malaise and general aches.
Dull and continuous frontal headache is prominent. Nose
bleeding, vague abdominal pain and constipation in 10% of
patients.
Second week- Sustained temperature (fever). Severe illness
with weakness, mental dullness or delirium, abdominal
discomfort and distension. Diarrhea is more common than first
week and feces may contain blood.
26
Diagnosis
Treatment
1. Ampicillin or co-trimoxazole for carriers and mild cases.
2. Chloramphenicol or ciprofloxacin or ceftriaxone for
seriously ill patients.
27
Nursing care
1. Maintain body temperature to normal.
2. Apply comfort measures.
3. Follow side effects of drugs.
4. Monitor vital signs.
5. Follow strictly enteric precautions:
wash hands
wear gloves
bowel perforation
abdominal rigidity
28
Infectious agent
Shigella is comprised of four species or serotypes.
Group A= Shigella dysentraie (most common cause)
Group B= Shigella flexneri
Group C= Shigella boydii
Group D= Shigella sonnei
Epidemiology
Occurrence- It occurs worldwide, and is endemic in both
tropical and temperate climates. Outbreaks commonly occur
under conditions of crowding and where personal hygiene is
poor, such as in jails, institutions for children, day care
29
30
Clinical Manifestation
Diagnosis
Treatment
1. Fluid and electrolyte replacement
2. Co-trimoxazole in severee cases or Nalidixic acid in the
case of resistance.
31
3. Proper
excreta
disposal
especially
from
patients,
Infectious agent
Entamoeba histolytica
Epidemiology
Occurrence- worldwide but most common in the tropics and
sub-tropics. Prevalent in areas with poor sanitation, in mental
institutions and homosexuals. Invasive amoebiasis is mostly a
disease of young people (adults). Rare below 5 years of age,
especially below 2 years.
Mode of transmission Fecal-oral transmission by ingestion
of food or water contaminated by feces containing the cyst.
Acute amoebic dysentery poses limited danger.
32
Life cycle
TRANSMISSION
1. Cysts ingested in food, water
or from hands contaminated with
feces.
6.
ENVIRONMENT
Feces containing infective cysts
contaminate the environment.
HUMAN HOST
cysts excyst, forming
trophozoites
3. Multiply in intestine
4. Trophozoites encyst.
5. Infective cysts passed in
feces.*
* trophozoites passed in feces
disintegrate.
2.
Fig. 3.2 Transmission and life cycle of Entamoeba histolytica. (From Monica
Chesbrough, 1998, District Laboratory Practice in Tropical Countries, Part
One, Cambridge University Press, London.)
33
Clinical Manifestation
Diagnosis
Treatment
1. Metronidazole or Tinidazole
disposal
of
human
excreta
(feces)
and
3.3.4 Giardiasis
Definition
A protozoan infection principally of the upper small intestine
associated with symptoms of chronic diarrhea, steatorrhea,
34
Infectious agent
Giardia lamblia
Epidemiology
Occurrence- Worldwide distribution. Children are more
affected than adults. The disease is highly prevalent in areas
of poor sanitation.
Reservoir- Humans
Mode of transmission- Person to person transmission
occurs by hand to mouth transfer of cysts from feces of an
infected individual especially in institutions and day care
centers.
Period of communicability- Entire period of infection, often
months.
Susceptibility and resistance- Asymptomatic carrier rate is
high. Infection is frequently self-limited. Persons with AIDS
may have more serious and prolonged infection.
35
Life cycle
TRANSMISSION
1. Cysts ingested in food,
water or from hands
contaminated with feces.
6.
ENVIRONMENT
Feces containing
infective cysts
contaminate the
environment.
HUMAN HOST
2.
cysts excyst,
forming
trophozoites
3.
Multiply in intestine
4.
Trophozoites
encyst.
5.
Infective cysts
passed in feces. *
* trophozoites passed in feces
disintegrate.
Fig. 3.3 Transmission and Life Cycle of Giardia Lamblia. (From Monica
Chesbrough, 1998, District Laboratory Practice in Tropical Countries, Part
One, Cambridge University Press, London.)
Clinical Manifestation
36
Diagnosis
Treatment
1. Metronidazole or Tinidazole
3.3.5 Cholera
Definition
An acute illness caused by an enterotoxin elaborated by vibrio
cholerae.
37
Infectious agent
Vibrio cholerae
Epidemiology
Occurrence- has made periodic outbreaks in different parts of
the
world
and
given
rise
to
pandemics.
Endemic
predominantly in children.
Reservoir- Humans
Mode of transmission- by ingestion of food or water directly
or indirectly contaminated with feces or vomitus of infected
person.
Incubation period- from a few hours to 5 days, usually 2-3
days.
Period of communicability- for the duration of the stool
positive stage, usually only a few days after recovery.
Antibiotics shorten the period of communicability.
Susceptibility and resistance- Variable. Gastric achlorhydria
increases risk of illness. Breast-fed infants are protected.
38
Clinical Manifestation
Diagnosis
Treatment
1. Prompt replacement of fluids and electrolytes
Nursing care
1. Wear gown and glove.
2. Wash your hands.
39
Definition
An acute viral disease characterized by abrupt onset of fever,
malaise, anorexia, nausea and abdominal discomfort followed
within a few days by jaundice.
Infectious agent
Hepatitis A virus
Epidemiology
Occurrence- Worldwide distribution in sporadic and epidemic
forms. In developing countries, adults are usually immune and
40
Clinical manifestation
Diagnosis
41
Treatment
Symptomatic: Rest, high carbohydrate diet with low fat and
protein.
3.4
42
3.4.1 Ascariasis
Definition
A helminthic infection of the small intestine generally
associated with few or no symptoms.
Infectious agent
Ascaris lumbricoides.
Epidemiology
Occurrence- The most common parasite of humans where
sanitation is poor. School children (5-10 years of age) are
most affected. Highly prevalent in moist tropical countries
Reservoir- Humans; ascarid eggs in soil.
Mode of transmission- Ingestion of infective eggs from soil
contaminated with human feces or uncooked produce
contaminated with soil containing infective eggs but not
directly from person to person or from fresh feces.
Incubation period- 4-8 weeks.
Period of communicability- As long as mature fertilized
female worms live in the intestine. Usual life span of the adult
worm is 12 months.
43
Life Cycle
TRANSMISSION
1. Infective eggs ingested in
food or from contaminated
hands
ENVIRONMENT
6.
7.
Eggs
become
infective
(embryonated) in soil in 30-40
days.
Infective eggs contaminate the
environment.
HUMAN HOST
2. Larvae hatch.
Migrate through liver and lungs.
3. Pass up trachea and are swallowed
4. Become mature worms in small
intestine
5. Eggs produced and passed in
feces.
Fig. 3.4 Transmission and life cycle of Ascaris lumbricoides. (From Monica
Chesbrough, 1998, District Laboratory Practice in Tropical Countries, Part
One, Cambridge University Press, London.)
Clinical Manifestation
44
Diagnosis
Treatment
1. Albendazole or
2. Mebendazole or
3. Piperazine or
4. Levamisole
Prevention and control
1. Treatment of cases
2. Sanitary disposal of feces
3. Prevent soil contamination in areas where children play
4. Promote good personal hygiene (handwashing).
3.4.2 Trichuriasis
Definition
A
nematode
infection
of
asymptomatic in nature.
45
the
large
intestine,
usually
Infectious agent
Trichuris trichuria (whip worm)
Epidemiology
Occurrence- Worldwide, especially in warm moist regions.
Common in children 3-11 years of age.
Reservoir- Humans
Mode of transmission- Indirect, particularly through pica or
ingestion of contaminated vegetables. Not immediately
transmissible from person to person.
Incubation period- Indefinite
Period of communicability- Several years in untreated
carriers.
Susceptibility and resistance- Susceptibility is universal.
46
Life Cycle
TRANSMISSION
1. Infective eggs ingested in food
or from contaminated hands
ENVIRONMENT
6. Eggs become infective
(embryonated) in soil after 3
weeks.
7. Infective eggs contaminate the
environment
HUMAN HOST
2. Larvae hatch.
Develop in small intestine.
Migrate to caecum.
3. Become mature worms.
4. Eggs produced and passed
in feces.
Fig. 3.5 Transmission and life cycle of Trichuris trichuria. (From Monica
Chesbrough, 1998, District Laboratory Practice in Tropical Countries, Part
One, Cambridge University Press, London.)
Clinical manifestation
47
Diagnosis
Treatment
1. Albendazole or
2. Mebendazole
3.4.3 Entrobiasis
(Oxyuriasis, pinworm infection)
Definition
A common intestinal helminthic infection that is often
asymptomatic.
Infectious agent
Entrobius vermicularis
48
Epidemiology
Occurrence- Worldwide, affecting all socio-economic classes
with high rates in some areas. Prevalence is highest in
school-aged children, followed by preschools and is lowest in
adults except for mothers of infected children. Prevalence is
often high in domiciliary institutions. Infection usually occurs in
more than one family member.
Reservoir- Human
Mode of transmission- Direct transfer of infective eggs by
hand from anus to mouth of the same or another person or
indirectly through clothing, bedding, food or other articles
contaminated with eggs of the parasite.
Incubation period- 2-6 weeks
Period of communicability- As long as gravid females are
discharging eggs on perianal skin. Eggs remain infective in an
indoor environment for about 2 weeks.
Susceptibility and resistance- Susceptibility is universal.
49
Life Cycle
Gravid females migrate through the
anus to the perianal skin and
deposit eggs (usually during the
night)
2-3 weeks
Adult worms
in Caecum
Migrate down
To caecum
Fig. 3.6 Transmission and life cycle of Entrobius vermicularis. (From Hegazi
M., 1994, Applied Human Parasitology, 1
st
Centers, Cairo.)
Clinical manifestation
Diagnosis
Treatment
1. Mebendazole.
Prevention and control
1. Educate the public about hygiene (i.e. handwashing
before eating or preparing food, keeping nails short and
discourage nail biting).
2. Treatment of cases
3. Reduce overcrowding in living accommodations.
4. Provide adequate toilets.
50
3.4.4. Strongyloidiasis
Definition
An often asymptomatic helminthic infection of the duodenum
and upper jejunum.
Infectious agent
Strongyloides stercolaris
Epidemiology
Occurrence- In tropical and temperate areas. More common
in warm and wet regions.
Reservoir- Human
Mode of transmission- Infective (filariform) larvae penetrate
the skin and enter the venous circulation.
Incubation period- 2-4 weeks (from skin penetration up to
when rhabditi form larvae appear in the feces).
Period of communicability- As long as living worms remain
in the intestine; up to 35 years in cases of auto-infection.
Susceptibility and resistance- Susceptibility is universal.
Patients with AIDS or on immuno-suppressive medication are
at risk of dissemination.
51
Life Cycle
TRANSMISSION
1. Infective filariform larvae
penetrate skin, e.g. feet.
Autoinfection also occurs.
HUMAN HOST
2. Larvae migrate, pass up trachea
and are swallowed.
3. Become mature worms in small
intestine
4. Eggs laid. Hatch rhabditiform
larvae in intestine.
5. Rhabditiform larvae:
- Passed in feces, or
- Become filariform larvae in
intestine, causing
atutoinfection.
ENVIRONMENT
6. In soil larvae become freeliving worms produce more
rhabditiform larvae*
* Free-living cycle can be
repeated several times
7. Become infective filariform
larvae in the soil
Clinical Manifestation
Diagnosis
52
Treatment
1. Albendazole or
2. Thiabendazole
Prevention and control
1. Proper disposal of human excreta (feces)
2. Personal hygiene including use of footwear.
3. Case treatment.
53
5.
2.
3.
4.
HUMAN HOST
Larvae migrate. Pass up trachea
and are swallowed.
Become mature worms in small
intestine (attach to wall and suck
blood).
Eggs produced and passed in
feces.
6.
7.
ENVIRONMENT
Eggs
develop;
Rhabditiform
larvae hatch. Feed in soil.
Develop into infective filariform
larvae in about 1 week.
Filariform larvae contaminate soil.
54
Clinical Manifestation
The clinical manifestation is related to:
1. Larval migration of the skin
Produces
transient,
localized
maculopapular
rash
3. Blood sucking
Diagnosis
Treatment
1. Mebendazole or
2. Albendazole or
3. Levamisole
Prevention and control
1. Sanitary disposal of feces
2. Wearing of shoes
3. Case treatment.
55
3.5.1 Poliomyelitis
Definition
A viral infection most often recognized by the acute onset of
flaccid paralysis.
Infectious agent
Polio viruses (type I, II and III)
Epidemiology
Occurrence Worldwide prior to the advent of immunization.
Cases of polio occur both sporadically and in epidemics.
Primarily a disease of infants and young children. 70-80% of
cases are less than three years of age. More than 90% of
infections are unapparent. Flaccid paralysis occurs in less
than 1% of infections.
Reservoir humans, especially children
Mode of transmission- Primarily person-to-person, spread
principally through the fecal-oral route. In rare instances, milk,
56
Clinical manifestation
The legs are more affected than other part of the body.
Diagnosis
57
Treatment
Symptomatic
Infectious agent
Echinococcus granulosus, a small tapeworm of dog
Epidemiology
Occurrence occurs on all continents except Antarctica.
Especially common in grazing countries where dogs consume
viscera containing cysts.
Reservoir- Domestic dogs and other canids are definitive
hosts; they may harbor thousands of adult tapeworms in their
58
Clinical manifestations
59
Diagnosis
Serologic test
Treatment
1. Surgical resection of isolated cysts is the most common
treatment.
2. Albendazol (mebendazol)
3. If cysts rupture, praziquantel
60
Review Questions
1.
2.
3.
61
CHAPTER FOUR
AIR-BORNE DISEASES
4.1
Learning Objectives
4.2
Introduction
62
Droplets that are bigger in size will not remain air-borne for
long but will fall to the ground. Here, however, they dry and
mix with dust. When they contain pathogens that are able to
survive drying, these may become air-borne again by wind or
something stirring up the dust, and they can then be inhaled.
Air-borne diseases, obviously, will spread more easily when
there is overcrowding, as in overcrowded class rooms, public
transport, canteens, dance halls, and cinemas. Good
ventilation can do much to counteract the effects of
overcrowding. Air-borne diseases are mostly acquired through
the respiratory tract.
4.3
Definition
An acute catarrhal infection of the upper respiratory tract.
Infectious agent
Rhino viruses (100 serotypes) are the major causes in adults.
Parainfluenza viruses, respiratory syncytial viruses (RSV),
Influenza, and Adeno viruses cause common cold-like
illnesses in infants and children.
63
Epidemiology
Occurrence- Worldwide both in endemic and epidemic forms.
Many people have one to six colds per year. Greater
incidence in the highlands. Incidence is high in children under
5 years and gradually declines with increasing age.
Reservoir- Humans
Mode of transmission- by direct contact or inhalation of
airborne droplets. Indirectly by hands and articles freshly
soiled by discharges of nose and throat of an infected person.
Incubation period- between 12 hours and 5 days, usually 48
hours, varying with the agent.
Period of communicability- 24 hours before onset and for 5
days after onset.
Susceptibility and resistance- Susceptibility is universal.
Repeated infections (attacks) are most likely due to multiplicity
of agents.
Clinical Manifestation
64
Diagnosis
Treatment
1. No effective treatment but supportive measures like
:
Bed rest
Steam inhalation
Anti pain
Handwashing
65
Epidemiology
Occurrence- Prior to widespread immunization, measles was
common in childhood so that more than 90% of people had
been infected by age 20; few went through life without any
attack.
Reservoir- Humans
Mode of transmission- Airborne by droplet spread, direct
contact with nasal or throat secretions of infected persons and
less commonly by articles freshly solid with nose and throat
secretion. Greater than 94% herd immunity may be needed to
interrupt community transmission.
Incubation period- 7-18 days from exposure to onset of
fever.
Period of communicability- slightly before the prodromal
period to four days after the appearance of the rash and
minimal after the second day of rash.
Susceptibility and resistance- All those who are nonvaccinated or have not had the disease are susceptible.
Permanent immunity is acquired after natural infection or
immunization.
66
Clinical Manifestation
Leucopoenia is common.
Diagnosis
Treatment
1. No specific treatment
2. Treatment of complications
3. Vitamin A provision
Nursing care
1. Advise patient to have bed rest.
2. Relief of fever.
3. Provision of non-irritant small frequent diet.
4. Shorten the fingernails.
Prevention and control
1. Educate the public about measles immunization.
67
4.5 Influenza
Definition
An acute viral disease of the respiratory tract
Infectious agent
Three types of influenza virus (A,B and C)
Epidemiology
Occurrence-
In
pandemics,
epidemics
and
localized
outbreaks.
Reservoir- Humans are the primary reservoirs for human
infection.
Mode of transmission- Airborne spread predominates
among crowded populations in closed places such as school
buses.
Incubation period- short, usually 1-3 days
68
Diagnosis
Treatment
1. Same as common cold, namely:
Bed rest
69
hydrochloride
is
effective
in
the
4.6 Diphtheria
Definition
An acute bacterial disease involving primarily tonsils, pharynx,
nose, occasionally other mucus membranes or skin and
sometimes the conjunctiva or genitalia.
Infectious agent
Corynebacterium diphtheriae
Epidemiology
Occurrence- Disease of colder months in temperate zones,
involving primarily non-immunized children under 15 years of
age. It is often found among adult population groups whose
immunization was neglected. Unapparent, cutaneous and
wound diphtheria cases are much more common in the
tropics.
Reservoir- Humans
Mode of transmission- contact with a patient of carrier. i.e.
with oral or nasal secretions or infected skin.
70
immunity.
Immunity
is
often
acquired
through
Clinical Manifestation
grayish
membrane
with
surrounding
71
Diagnosis
Treatment
1. Diphtheria antitoxin
2. Erythromycin for 2 weeks but 1 week for cutaneous form
or
3. Procaine penicillin for 14 days or single dose of Benzathin
penicillin
Primary goal of antibiotic therapy for patients or carriers is to
eradicate C. diphtheriae and prevent transmission from the
patient to susceptible contacts.
72
Infectious agent
Bordetella pertusis
Epidemiology
Occurrence- An endemic disease common to children
especially young children everywhere in the world. A marked
decline has occurred in incidence and mortality rates during
the past four decades. Outbreaks occur periodically. Endemic
in developing world and 90% of attacks occur in children
under 6 yearsof age.
Reservoir- Humans
Mode of transmission- Primarily by direct contact with
discharges from respiratory mucus membranes of infected
persons by airborne route, probably by droplets. Indirectly by
handling objects freshly solid with nasopharyngeal secretions.
Incubation period- 1-3 weeks
73
and
resistance-
Susceptibility
to
non-
2. Paroxysmal phase
74
3. Convalescent phase
Diagnosis
History
and
physical
examination
at
phase
two
Marked lymphocytosis.
Treatment
1. Erythromycin- to treat the infection in phase one but to
decrease transmission in phase two
2. Antibiotics for super infections like pneumonia because of
bacterial invasion due to damage to cilia.
Nursing care
1. Proper feeding of the child.
2. Encourage breastfeeding immediately after an attack
(each paroxysm).
3. Proper ventilation- continuous well humidified oxygen
administration.
4. Reassurance of the mother (care giver),
75
Infectious agent
Streptococcus pneumoniae (pneumococcus)
Epidemiology
Occurrence- Endemic particularly in infancy, old age and
persons with underlying medical conditions. Epidemics can
occur in institutions, barracks and on board ship where people
are living and sleeping in close quarters. Common in lower
socio-economic groups and developing countries.
Reservoir- Humans - pneumococci are usually found in the
URT of healthy people throughout the world.
76
Clinical Manifestation
77
Diagnosis
Treatment
1. Antipyretic and antipain
2. Antibiotics like Ampicillin or procaine penicillin for adults
but usually crystalline penicillin for children
3. Anticonvulsants for infants.
Nursing care
1. Monitor vital signs especially of children.
2.
3. Intermittent
administration
of
humidified
oxygen
if
78
4.9
Meningococcal Meningitis
Definition
An acute bacterial disease that causes inflammation of the pia
and arachnoid space.
Infectious agent
Neisseria meningitides (the meningococcus)
Epidemiology
Occurrence- Greatest incidence occurs during winter and
spring. Epidemics occur irregularly. Common in children and
young adults. It is also common in crowded living conditions.
Reservoir- Humans
Mode of transmission- Direct contact with respiratory
droplets from nose and throat of infected person.
Incubation period- 2-10 day, commonly 3-4 days.
Period of communicability- as long as the bacteria is
present in the discharge.
Susceptibility and resistance- Susceptibility is low and
decreases with age
79
Clinical Manifestation
Diagnosis
Treatment
1. Admit the patient and administer high dose of crystalline
penicillin intravenously
2. Antipyretic
Nursing care
1. Maintain fluid balance (input and output)
2. Maintain body temperature to normal
80
4.10
Tuberculosis
Definition
A chronic and infectious mycobacterial disease important as a
major cause of illness and death in many parts of the world.
Infectious agent.
Mycobacterium
tuberculosis-
human
tubercle
(commonest cause)
Mycobacterium bovis- cattle and man infection
Mycobacterium avium- infection in birds and man.
81
bacilli
Epidemiology
Occurrence- Worldwide, however underdeveloped areas are
more affected. Affects all ages and both sexes. Age groups
between 15-45 years are mainly affected. According to the
WHO 1995 report, 9 million cases and 3 million deaths have
occurred. According to the Ministry of Health report in 1993
E.C, tuberculosis was a leading cause of outpatient morbidity
(ranked 8th with 2.2%), leading cause of hospitalization
(ranked 3rd with 7.8%) and leading cause of hospital death
(ranked 1st with 10.1%). Tuberculosis has two major clinical
forms.
Transmission
through
contaminated
fomites
82
Reactivation or
Reinfection
Clinical Manifestation
Pulmonary tuberculosis
83
TB lymph adenitis
Tuberculosis pleurisy
Intestinal TB
Tuberculos meningitis
Diagnosis
1. Clinical manifestations
2. Sputum smears for acid-fast bacilli (AFB), which is the
Golden standard. However, one positive result does not
84
examination:
Biopsies
for
Treatment
The following drugs are being used for treatment of TB in
Ethiopia.
Ethambutol(E)
Rifampin (R)
Thiacetazone (T)
Isoniazid (H)
Pyrazinamide (Z)
85
Nursing care
1. Educate the patient how and when to take the prescribed
medication.
2. Tell the patient not to stop the medication unless he/she is
told to do so.
3. Tell the patient to come to the health institution if he/she
develops drug side effects.
4. Advice the patient on the importance of taking adequate
and balanced diet and to eat what is available at home.
86
Adequate nutrition
Health housing
Environmental sanitation
Infectious agent
Mycobacterium leprae
87
Epidemiology
Occurrence-
Although
common
in
rural
tropics
and
lepromatous
patients.
Cutaneous
ulcers
in
88
Clinical Manifestation
Clinical manifestations vary between two polar forms:
lepromatous and tuberculoid leprosy.
Borderline
Has features of both polar forms and is more liableto shift
toward the lepromatous form in untreated patients and toward
the tuberculoid form in treated patients.
89
Diagnosis
Treatment
1. Dapsone
2. Refampicin
3. Clfazamin
4. Aspirin for mild reactions and inflammation
5. Severe reaction can be treated with corticosteroids
90
Review Questions
1. What
do
you
understand
by
air-borne
disease
transmission?
2. Which airborne disease occurrence should be reported
immediately to the concerned health authorities for their
prompt action?
a. Pneumonia
b. Tuberculosis
c.
Leprosy
d. Meningococcal meningitis
3. Select diseases which cause chronic illness:
a. Tuberculosis
b. Leprosy
c.
Measles
d. Infection hepatitis
4.
91
CHAPTER FIVE
ARTHROPOD OR INTERMEDIATE
VECTOR-BORNE DISEASES
5.1 Learning Objectives
At the end of this chapter, the student will be able to:
5.2 Introduction
Generally speaking a vector is any carrier of disease, but in
the case of the vector-borne diseases we restrict the word to
those invertebrate hosts (insects or snails), which are an
92
5.3.1 Malaria
Definition
An acute infection of the blood caused by protozoa of the
genus plasmodium.
93
Infectious agent.
Invades all
Plasmodium
Malariae/Quartan
malaria:
Invades
Epidemiology
Occurrence- Endemic in tropical and sub-tropical countries of
the world. Affects 40% of the world population. Children less 5
years of age, pregnant women and travelers to endemic areas
are risk groups. Plasmodium falciparum 60% and vivax 40%
are common in Ethiopia.
Predisposing factors are:
Patient source
Susceptible recipients
94
Reservoir- Humans
Mode of transmission- By the bite of an infective female
anopheles mosquito, which sucks blood for egg maturation.
Blood transfusion, hypodermic needles, organ transplantation
and mother to fetus transmission is possible. Since there is no
pre-erythrocytic (tissue) cycle, the incubation period is short.
Anopheles gambae and funestus are common vectors in
Ethiopia.
Incubation period- Varies with species
95
Specific factors
This is a humoral and cell mediated immunity that is species
and strain specific, and hard-won after repeated infection.
Life cycle
TRANSMISSION
1. Sporozoites inoculated when Anopheles
mosquito takes a blood meal.
6.
2.
3.
4.
5.
HUMAN HOST
Sporozoites infect liver cells. Multiply
by schizogony.
Note: some sporozoites of P.vivax and
p.ovale become dormant hypnozoites
in liver. Become active after several
months.
Liver schizonts rupture. Merozoites
enter red cells, become trophozites.
Multiply by schizogony.*
* with P. falciparum, schizogony
occurs in capillaries of body organs.
Schizonts rupture. Merozoites infect
new red cells.
Some merozoites develop into male
and female gametocytes.
Fig. 5.1
7.
8.
9.
MOSQUITO
gametocytes ingested by
mosquito.
Male and female gametes
fuse. Zygote oocyst in
stomach wall.
Sporozoites form in oocyst.
Oocyst ruptures.
Sporozoites reach salivary
glands of mosquito
96
Clinical Manifestation
Chills, rigor, fever, head ache, diarrhea, hallucinations,
abdominal pain, aches, renal or respiratory symptoms,
jaundice, etc.
Diagnosis
Treatment
1. Plasmodium vivax, ovale and sensitive plasmodium
falciparum
Chloroquine or
Fansidar
Quinine or
Fansidar
Nursing care
1. Advise patient to come back if the illness gets severe.
2. Advise on personal protection (bed nets, etc).
3. Reduce fever and maintain comfort.
97
3. Chemotherapy of cases
Infectious agent
Wucheriria bancrofti (vectors are culex, Anopheles and Aedes
species)
Brugia malayi and (vector is mansonia species)
Brugia timori (vector is Anopheles)
98
Epidemiology
Occurrence- Widely prevalent in tropical and subtropical
areas of Africa, Asia, Pacific Region, Central and South
America. Found in Gambella region (western Ethiopia).
Reservoir- Humans are definitive hosts.
Mode of transmission- by bite of mosquito harboring
infective larvae
Incubation period- one month, while allergic inflammatory
manifestations may appear.
Period of communicability- Humans may infect mosquitoes
when microfilariae are present in the peripheral blood.
Microfilaremia may persists for 5-10 years or longer. The
mosquito becomes infective about 12-14 days after an
infective blood meal.
Susceptibility and resistance- Universal. Susceptibility to
infection is probable.
99
Life cycle
TRANSMISSION
1. Infective larvae penetrate skin
when a mosquito takes a blood
meal.
4.
5.
HUMAN HOST*
Larvae become adult worms
in the lymphatics.
3. Females produce sheathed
Microfilariae which pass into
blood.
* Animal hosts may be important for
B. Malayi.
2.
6.
MOSQUITO
Microfilariae ingested by
mosquito.
Microfilariae lose sheath.
Develop into infective larvae
in thoracic muscles.
Infective larvae (sheathed)
migrate to mouth parts.
Fig. 5.2 Transmission and life cycle of W. bancrofti and Brugia species (From
Monica Chesbrough, 1998, District Laboratory Practice in Tropical Countries,
Part One, Cambridge University Press, London.)
Clinical Manifestation
The presence of worms in the lymph vessels gives rise to a
foreign-body reaction. After the death of the worm, more
proteins are released; the reaction then is even more severe.
Three phases may be distinguished.
Acute phase:
Lymphadenopathy
Fever
100
Eosinophilia
Subacute phase:
Chronic phase:
101
Diagnosis
102
Treatment
1. Diethyl carbamazin Citrate (DEC) results in rapid
disappearance of most microfilariae from blood but may
not destroy the adult worm. Because of this, we need to
repeat DEC annually for some years.
2. Refer the patient for surgical treatment of hydrocele.
Infectious agent
Yellow fever virus
Epidemiology
Occurrence- The disease exists in two transmission cycles.
Namely, the sylvatic or Jungle cycle, which occurs between
mosquitoes and non-human primates, and an urban cycle,
103
104
Clinical Manifestation
Diagnosis
Clinical manifestation
Treatment
No specific treatment.
Nursing care
1. Monitor vital signs regularly.
2. Maintain body temperature to normal.
3. Monitor input and output balance.
4. Keep patient in screened rooms or under mosquito nets to
avoid further infection.
105
necessarily
exposed
to
infection
because
of
106
under
appropriate
climatic
conditions.
107
Clinical Manifestation
Bubonic plague- Characterized by swelling of lymph glands
(bubos); mostly the glands of the groins, sometimes arm pit or
other places. Swelling may be the size of an egg, tender or
non-tender. Other symptoms are:
Shock
Prostration
Coma
Pneumonic plague
Acute onset
Severe prostration
Pleural effusion
Diagnosis
Treatment
1. Early treatment with antibiotics like streptomycin or
tetracycline or sulfa groups.
108
Definition
A rickettsial disease whose course resembles that of louseborne typhus, but is milder.
Infectious agent
Rickettsia typhi (Rickettsia mooseri)
Epidemiology
Occurrence- Worldwide, found in areas where people and
rats occupy the same buildings and where large numbers of
mice live. Occurs sporadically.
Reservoir-Rats, mice and possibly other small animals.
Infection is maintained in nature by a rat-flea-rat cycle where
rats are reservoirs (Commonly rattus and rattus novergicus).
109
Pulmonary
involvement:
non-productive
pneumonia.
Diagnosis
Epidemiological ground
110
cough
and
Treatment
1. Doxycyclin or
2. Chloramphenicol
Infectious agent
Rickettsia Prowazeki
Epidemiology
Occurrence- In colder areas where people may live under
unhygienic
conditions
and
are
louse-infected.
Occurs
111
Clinical Manifestation
112
disease,
skin
rash
singly
or
in
combination.
Diagnosis
Treatment
1. Chloramphenicol or Tetracycline
113
Infectious agent
Borrelia recurrentis- cause of louse-borne relapsing fever
Borrelia duttoni-cause of tick-borne relapsing fever
Epidemiology
Occurrence- Occurs in Asia, eastern Africa (Ethiopia and
Sudan), the highland areas of central Africa and South
America. It occurs in epidemic form when it is spread by lice
and in endemic form when spread by ticks.
Reservoir- Humans for Borrelia recurrentis; , wild rodents and
soft ticks through transovarian transmission. for tick borne
relapsing fever
Mode of transmission- vector-borne. Acquired by crushing
an infected louse so that it contaminates the bite wound or an
abrasion of the skin.
Incubation period- 5-10 days usually 8 days.
Period of communicability- Louse becomes infective 4-5
days after ingestion of blood from an infected person and
remains so for life (20-40 days)
114
Clinical Manifestation
After 4-5 days the temperature comes down, the patient stays
free for 8-12 days and then a relapse follows with the same
signs but less intense.
In untreated cases there may be up to ten relapses.
Diagnosis
Treatment
1. Admit the patient.
2. Open vein (i.e. start iv-line) before administering penicillin.
3. Administer 400,000-600,000 IU procaine penicillin IM stat
4. Tetracycline during discharge for 3 days
5. Chloramphenicol in infants and children can be used in
place of tetracycline.
115
Nursing care
1. Maintain body temperature to normal.
2. Close vital sign monitoring for 3 hours after medication.
3. Check whether there is reaction or not and report.
4. Comfort the patient by providing antipain.
5. Shaving of hair, and delousing of clothes.
116
Infectious agent
The major schistoma species that cause schistosomiasis of
humans are:
Schistosoma mansoni
Schistosoma Japonicum
Schistosoma Hematobium
Others in limited areas are S. mekongi, S. intercalatum, S.
malayesis, S. mattheei.
Most prevalent species in Africa are S. mansoni and S.
hematobium.
Snail vectors are:
Bulinus-S. hematobium
Biomphalaria-S. mansoni
Onchomelania-S. japonicum
Epidemiology
Occurrence- S. mansoni is found in South America,
Caribbean Islands, Africa and the Middle East. S. hematobium
is found in Africa and the Middle East. S. Japonicum is found
in the Far East. The disease occurs worldwide and 2 million
people are expected to be infected; however, most infected
individuals show few or no signs and symptoms, and only a
small minority develop significant disease.
117
Reservoir-The
principal
reservoir
for
S.
mansoni,
S.
immediately
before
and
during
initial
egg
118
Life cycle
TRANSMISSION
1. Cercariae penetrate skin when
person in contact with contaminated
water
7.
HUMAN HOST*
2. Cercariae Schistosomula.
Migrate through lungs and
liver.
3. Become mature flukes in
portal venous system. Flukes
pair.
4. Migrate to veins of lower large
intestine (S. haematobium to
veins of bladder)
5. Eggs laid in venules. Burrow
through into intestine (eggs of
S. haematobium into bladder)
6. Eggs passed in feces. (S.
haematobium in urine).
*S. japonicum also infects animals.
FRESH WATER
Eggs
reach
water.
Miracidia hatch
Snail host
Miracidia penetrate snail.
Become sporocysts and
multiply (2 generations).
Sporocysts cercariae.
9. Cercariae leave snail.
(S.Japonicum attaches to
water
vegetation).
8.
Fig. 5.3 Transmission and life cycle of Schistosoma species. (From Monica
Chesbrough, 1998, District Laboratory Practice in Tropical Countries, Part
One, Cambridge University Press, London.)
Clinical Manifestation
The stages of schistosomiasis are:
A. invasion
B. maturation
C. established infection and
D. late stage.
119
A. Invasion stage
B. Maturation
Fever,
eosinophilia,
abdominal
pain
and
transient
veins
in
the
intestinal
wall
and
S.
C. Established infection
Eggs that could not penetrate the tissue are carried with
blood to the liver and lungs.
120
D. Late stage
Dilatation
of
ureters
(hydroureter)
and
kidney
Calcification of bladder.
Diagnosis
Treatment
121
122
Infections agent
Dracunculus medinensis, a nematode
Epidemiology
Occurrence- In Africa (16 countries south of the Sahara) and
in Asia (India and Yemen) especially in regions with dry
climates. Local prevalence varies greatly. In some locales,
nearly all inhabitants are infected, in others, few, mainly young
adults.
Reservoir- Humans
Mode of transmission- Larvae discharged by the female
worm into stagnant
123
When the blister ruptures, the adult worm releases larvarich fluid and this is associated with a relief of symptoms.
Diagnosis
124
Treatment
1. Gradual extraction of the worm by winding of a few
centimeters on a stick each day remains the common and
effective practice. Worms may be excised surgically.
2. Administration of thiabendazole or metronidazol may
relive symptoms but has no proven activity against the
worm.
health
education
programs
in
endemic
125
Review Questions
1. What do you understand by vector-borne disease
transmission?
2. Which of the vector-borne diseases pose major health
problems in Ethiopia?
3. Except one, others do not require notification to the health
authorities
a) Malaria
b) Yellow fever
c) Plague
d) B and C
e) Schistosomiasis
4. What are the preventive and control methods for malaria
and schistosomiasis?
126
CHAPTER SIX
SEXUALLY TRANSMITTED
DISEASES
6.1 Learning Objectives
At the end of this chapter, the student will be able to:
6.2. Introduction
The diseases belonging to this group are usually transmitted
during
sexual
intercourse;
hence
the
name
sexually
127
128
Infectious agent
Treponema pallidum, a spirochete.
Epidemiology
Occurrence: Worldwide spread. Primarily involving sexually
active young people between 20 and 29 years. More common
in urban than rural areas.
Reservoir
- Humans
129
Clinical Manifestation
The clinical presentation is divided into three groups:
a) Primary syphilis consists of hard chancre, the primary
lesion of syphilis, together with regional lymphadenitis.
The hard chancre is a single, painless ulcer on the
genitalia or elsewhere (lips, tongue, breasts) and heals
spontaneously in a few weeks without treatment.
The lymph glands are bilaterally enlarged and not painful.
There will not be suppuration.
130
and
mucosal
surfaces.
Other
disabling
Diagnosis
131
Treatment
1. Primary and secondary syphilis
2. Tertiary syphilis
Provision of condom
132
133
without
antibiotic
treatment.
Antibiotic
therapy
Diagnosis
Culture.
Treatment
1. Co- trimorazele or
2. Erythromycin or
3. Tetracycline can be used
N.B. Do not incise lymph nodes even with fluctuation because
they will completely heal with treatment.
134
of
contacts,
source
of
infection
and
treatment
3. Thorough washing of genitalia with soap and water
promptly after intercourse is very effective.
4. Controlling STDs among commercial sex workers
5. Sex education for high risk groups
135
Diagnosis
136
Treatment
1. Tetracycline or
2. Erythromycin or
3. Co -trimoxazole can be used
4. Aspiration of fluctuating bubo and wound care
of
contacts,
source
of
infection
and
treatment
3. Controll STDs among commercial sex workers
4. Sex education for high risk groups
6.6
Herpes Genitalia
Definition
A viral infection characterized by a localized primary lesion,
latency and a tendency to localized recurrence.
Infectious agent
Herpes simplex virus (HSv) type 2
Epidemiology
Occurrence worldwide. HSV 2 infection usually begins with
sexual activity and is rare before adolescence, except in
sexually abused children. Prevalence is greater (up to 60%) in
137
canal,
but
less
commonly
occurs
intrauterine or postpartum
Incubation period 2 12 Days
Period of communicability Patients with primary genital
lesions are infective for about 7 12 days, with recurrent
disease for 4 days to a week. Reactivation of genital herpes
may occur repeatedly in > 50% of women.
Susceptibility and resistance Humans are universally
susceptible.
Clinical manifestation
138
Treatment
1. Oral acyclovir is effective
Prevention and control
1. Consistent use of condom is an effective means of
reducing the risk of genital HSv 2 transmission.
6.7
Candidiasis
Definition
A mycosis usually confined to the superficial layers of skin or
mucus membranes, presenting clinically as oral thrush or
vulvovaginitis.
Infectious agent
Candida albicans (most common cause)
Candida tropicalis (rare cause)
139
Epidemiology
Occurrence Worldwide. Candida albicans is often part of
the normal human flora.
Reservoirs Humans
Mode of transmission contact with secretions or excretions
of mouth, skin, vagina and feces, from patients or carriers.
Passage from mother to neonate during childbirth.
Incubation period variable.
Period of communicability - presumably while lesions are
present.
Susceptibility and resistance Susceptibility is very low
except in low host defense. It is common in diabetes, HIVinfected; women are prone to vulvovaginitis in the third
trimester of pregnancy. Oral contraceptive users, individuals
with prolonged steroid therapy are susceptible.
Clinical manifestation
140
Diagnosis
Treatment
1. Nystatine vaginal pessary or
2. Miconazole or clotrmazele creams or
3. Keto conazole or
4. Fluconazele in recurrent cases
Prevention and control
1. Case treatment
2. Treatment of underlying medical conditions or predisposing
factors
6.8 Gonorrhea
Definition
An acute or chronic purulent infection of the urogenital tract.
Infectious agent
Neisseria gonorrhea, the gonococcus
141
Epidemiology
Occurrence worldwide, affecting both genders, especially
sexually active adolescents and young adults. Common in
rural areas. Prevalent in communities of lower socio-economic
status. In most industrialized countries, the incidence has
decreased during the past two decades.
Reservoir - Strictly a human disease
Mode of transmission - almost always as a result of sexual
activity
Incubation period - usually 2-7 days
Period of communicability - may extend for months in
untreated individuals. Effective therapy ends communicability
within hours.
Susceptibility and resistance - Susceptibility is general. No
immunity following infection and reinfection is common.
Clinical manifestations
Males- Usually involves the urethra resulting in purulent
discharge, dysurea and frequency.
Females - Females are usually asymptomatic. Vaginal
discharge is common.
142
Diagnosis
Treatment
1. Co - trimoxazole or
2. Erythromycin or
3. Ceftriaxone can be used
Prevention and control
1. The same as syphilis
2. Application of 1% tetracycline in both eyes of newborne
as soon as delivered.
6.9
Trichomoniasis
Definition
A common and persistent protozoal disease of the genitourinary tract.
Infectious agent
Trichomonas vaginalis, a flagellate protozoan
143
Epidemiology
Occurrence - worldwide spread, a frequent disease of all
continents and all races, primarily of adults, with the highest
incidence among females 16 - 35 years. Overall, about 20%
of females may become infected during their reproductive
years.
Reservoir - Humans.
Mode of transmission- by contact with vaginal and urethral
discharges of infected people during sexual intercourse.
Indirectly through contact with contaminated articles and
clothes.
Incubation period - 4 - 20 days, average 7days. Many are
symptom-free carriers for years.
Period of communicability - the duration of the persistent
infection, which may last for years.
Susceptibility and resistance -Infection is general, but
clinical disease is seen mainly in females.
Clinical manifestation
144
Diagnosis
Treatment.
1. Metronidazole or
2. Clotrimazole vaginal suppository for pregnant women
cures up to 50%.
145
6.10 HIV/AIDS
Definition
A severe, life - threatening clinical condition, first recognized
as a distinct syndrome in 1981. This syndrome represents the
late clinical stage of infection with the human immunodeficiency virus (HIV), which most often results in progressive
damage to the immune and other organ systems, including
the CNS.
Infections agent
Human immuno-deficiency virus (HIV) (HIV-1 and HIV-2 )
Epidemiology
Occurrence - worldwide spread pandemic. HIV -1 infections
are now distributed worldwide, but are most prevalent in SubSaharan Africa, the Americas, western Europe and southern
and Southeast Asia. HIV -2 has been found primarily in West
Africa, with some cases in the western hemisphere and other
African countries that are linked epidemiological to West
Africa.
The MOH 2002 report depicts the following about the
HIV/AIDS situation in Ethiopia:
-
146
147
Clinical manifestations
Acute HIV syndrome. Occurs 3 - 6 weeks after primary
infection. Clinical findings in the acute syndrome are: fever,
pharyngitis, lymphadenopathy, head ache, retro-orbital pain,
arthralgias, myalgias, lethargy or malaise, anorexia, weight
loss, nausea or vomiting or diarrhea. Meningitis, Encephalitis,
peripheral
neuropathy,
myopathy,
erythematous
Diagnosis
148
Treatment
1. No specific treatment.
2. Treatment of opportunistic infections.
3. Use of anti-HIV drug to reduce transmission of the virus to
the fetus of pregnant mothers reduces fetal infection.
149
Review Questions
1. What are the common sexually transmitted infections?
2. What is the basic difference in the clinical manifestation of
syphilis, Chancroid and Herpes genitalia?
3. What are the common preventive and control methods
applicable to all STIs?
150
CHAPTER SEVEN
ZOONOTIC DISEASES
7.1
Learning Objectives
7.2
Introduction
151
7.3
Food of Animals
7.3.1Taeniasis
Definition
Taeniasis is an intestinal infection with the adult stage of large
tapeworms. Cysticercosis is a tissue infection with the larval
stage.
Infectious agent
Taenia saginata (beef tapeworm)
Taenia solium (pork tapeworm)
Epidemiology
Occurrence- Worldwide; frequent where beef or pork is eaten
raw or insufficiently cooked and where sanitary conditions
permit pigs and cattle to have access to human feces.
Prevalent in Latin America, Africa, South East Asia and
Eastern Europe.
Reservoir- Humans are definitive hosts of both species of
Taenia; cattle are the intermediate hosts for Taenia saginata
and pigs for Taenia solium.
Mode of transmission- Eggs of Taenia saginata passed in
the stool of an infected person are infectious only to cattle in
the flesh of which the parasites develop into cysticercus
152
months.
Susceptibility and resistance- Susceptibility is general. No
apparent resistance follows infection but more than one
tapeworm in a person has rarely been reported.
153
Life cycle
TRANSMISSION
1. Cysticerci ingested in
undercooked meat. T. saginata
in beef T. solium in pork.
6.
7.
8.
2.
3.
4.
5.
ENVIRONMENT
Segments and eggs reach ground
where animals feed.
Animal host:
Cattle for T. saginata pig for T. solium
Eggs ingested.
Embryos carried to muscles. Develop
into infective cysticerci.
HUMAN HOST
Cysticerci attached to wall of
small intestine.
Become mature tapeworms
Eggs released when gravid
segments become
detached.
Eggs and gravid segments
passed in feces.
Fig.7.1 Transmission and life cycle of Taenia solium and Taenia saginata.
(From Monica Chesbrough, 1998, District laboratory practice in tropical
countries, part one, Cambridge University press, London.)
154
Usually asymptomatic.
Passage of proglottidis.
Diagnosis
Treatment
1. Single dose of praziqantel is highly effective or
2. Niclosamide or
3. Dechlorophil or
155
4. Mebendazole or
5. Albendazole
T. Solium
Cysticercosis management
-
Chemotherapy
For
symptomatic
patients
with
neurocysticercosis,
Use latrines.
156
7.3.2 Brucellosis
Definition
A systemic bacterial disease with acute or insidious onset
transmitted to humans from infected animals.
Infectious agent
Brucella melitensis (most common worldwide),
acquired
Epidemiology
Occurrence- Worldwide. Predominantly an occupational
disease of those working with infected animals or their tissues
especially farm workers, veterinarians and abattoir workers,
which is more frequent among males. Outbreaks can occur
among consumers of raw milk and milk products, especially
unpasteurized soft cheese from cows, sheep and goats.
Reservoir- cattle, swine, goats and sheep, pet dogs.
157
Clinical manifestation
158
Reactive
asymmetric
polyartaritis
(knees,
hips,
Diagnosis
Treatments
159
Infectious agent
Trichinella spiralis, an intestinal nematode
Epidemiology
Occurrence - Worldwide, but variable incidence, depending
in part on practices of eating and preparing pork or wild
animal meat.
160
Clinical manifestation
161
Weakness or prostration
Pain on swallowing
Diarrhea
Abdominal cramps
Meningitis
Encephalitis
Myocarditis
Broncho-pneumonia
Nephritis
Diagnosis
Eosinophilia
Treatment
1. Hospitalization of the patient
2. Mebendazole or
162
3. Albendazole or
4. Thiabendazole
5. High doses of corticosteroids for 1-2 days followed by
lower doses for several days or weeks. But not for
intestinal stage.
7.3.4 Toxoplasmosis
Definition
Toxoplasmosis is a systemic protozoal disease that can be
either acute or chronic type with intracellular parasite.
Toxoplasma gondii in which the parasite is responsible for the
development
of
clinically
evident
disease,
Infectious agent
Toxoplasma gondii
163
including
Epidemiology
Occurrence- Worldwide in mammals and birds. Infection in
man is common. In the United States and most European
countries, the prevalence of sero-conversion increases with
age and exposure. In Central America, France, Turkey and
Brazil, sero-prevalence is much higher, approaching 90% by
age of 40.
Reservoir- The definitive hosts are cats and other felines,
which acquire the infection mainly from eating infected
mammals (especially rodents) or birds and rarely from feces
of infected cats. Only felines harbor the parasite in the
intestinal tract where the sexual stages of its life cycle takes
place, which result in the excretion of the oocyst in feces for
10-20 days or rarely longer. The intermediate hosts of T.
gondii include sheep, goats, rodents, cattle, chicken and birds.
Intermediate hosts are man and other animals.
The life cycle can be either hetroxenous (requiring two hosts)
or monoxenous (one host). Both sexual and asexual
reproduction occur in man.
There are five main developmental forms in the life cycle, but
only trophozoites and cyst stages are found in human. All
stages occur in the felines (cats).
164
Mood of Transmission
1. Ingestion of cysts in raw or under-cooked meat
2. Ingestion of oocysts in food, drink or from hands
contaminated with feces of an infected cat.
3. Transplacental/congenital
4. Blood transfusion
5. Organ transplantation
Incubation period- from 10-23 days. One common source
outbreak from ingestion of under-cooked meat is possible.
Period of communicability- Not directly transmitted from
person to person, except in utero. Oocysts shed by cats
sporulate and become infective 1-5 days later and may
remain infective in water or moist soil for about a year.
Cysts in the flesh of an infected animal remain infective as
long as the meat is edible and uncooked.
165
Clinical manifestation
General symptoms: Although severe symptoms may be
noted, Toxoplasmosis gondii symptoms are mild and mimic
those seen in cases of infectious mononucleosis. The acute
form of this disease is characterized by fatigue, lymphodenitis,
chills, fever, headache and myalgia. In addition to chronic
disease, the patient may develop maculopapular rash,
encephalomyelitis
and
hepatitis;
retinochoriditis
with
child
include
hydrocephaly,
microcephaly,
166
Diagnosis
Serological test
cell culture
Treatment
1. Treatment is not routinely indicated for a healthy immunocompetent host, except in an initial infection during
pregnancy or the presence of active choreoretinitis and
myocarditis or other organ involvement.
2. The
preferred
treatment
for
those
with
severe
167
8) Blood intended for transfusion into Toxoplasma seronegative immuno-compromised individuals should be
screened for antibody to toxoplasma gondii.
9) Patients with HIV/AIDS who have severe symptomatic
toxoplasmosis should receive prophylactic treatment
(Prymethamine, sulfadizine, folinic acid) throughout their
life span.
168
169
Clinical Manifestation
The clinical manifestation, which is the same in all species
including humans, has 3 phases:
Prodromal phase
Excitatory phase
Paralytic phase
170
Diagnosis
Treatment
1. Wound Care
171
Infectious agent
Bacillus anthracis, spore forming bacteria.
Epidemiology:
Occurrence- Worldwide. Primarily a disease of herbivores.
Humans and carnivores are incidental hosts. Primarily an
occupational hazard of workers who process hides, hair
(especially from goats), bone and bone products and wool:
and of veterinarians and agriculture and wildlife workers who
handle
infected
animals.
Human
anthrax
is
common
172
Mode of transmission
Intestinal
and
oropharyngeal
anthrax:
ingestion
of
N:B.
through:
173
174
painful
non-specific
regional
lymphadenitis
is
common.
Inhalation anthrax
175
Oropharyngeal anthrax
Fever,
sore
throat,
dysphagia,
painful
regional
Diagnosis
Clinical data
Treatment
For Cutaneous anthrax
1. Penicillin-G IV until edema subsides and with subsequent
oral penicillin to complete the course (adults). For
Penicillin-sensitive adults, Ciprofloxacin, erythromycin,
Tetracycline, Chloramphenicol can be substituted.
2. Clean and cover the cutaneous lesions.
For Inhalation anthrax, Gastrointestinal and Anthrax
meningitis
176
2. Vaccination
of
susceptible
groups
and
domestic
herbivores.
3. Carcasses of animals should be buried intact.
4. Butchering of infected animals should be avoided.
5. Education in mode of transmission and in care of skin
abrasions
for
employees
handling
potentially
contaminated articles.
6. Dust
control
and
proper
ventilation
in
hazardous
industries.
7. Treat all animals exposed to anthrax with Tetracycline or
penicillin.
Leishmania aethiopica*
177
Leishmania donovani. *
Leishmania infantum. *
Leishmania chagasi. *
178
CL:
Cutaneous
leishmaniasis
MCL:
Mucocutaneous
179
Clinical Manifestation
anemia,
leucopoenia,
thrombocy-
Diagnosis
Treatment
Pentalvalent antimonial agents
Pentamidine or
Amphotercin or
Aminoglycoside aminosidine or
Cytokine immunotherapy
180
Infectious agent
The commonest agents are:
T. Brucei rhodesiense
T. Brucei gambiense
Epidemiology
Occurrence-The trypanosomes that cause sleeping sickness
are found only in Africa. 20,000 new cases are reported each
year. This number surely under-estimates the true incidence.
T. brucei gambiense occurs and is widely distributed in the
tropical rainforests of Central and West Africa. Gambiense
trypanosomes are primarily a problem in rural population;
tourists rarely become infected. The principal reservoir of T.B
rhodesiense in savanna and woodland areas of Central and
East Africa are Trypotolerant antelope species. Humans
acquire T.B. rhodesiense infection only incidentally while
181
182
Life cycle
TRANSMISSION
1. Trypomastigotes injected
through skin when tsetse fly
takes a blood meal
TSETSEFLY
3. Trypomastigotes ingested by tsetse
fly
4. parasites multiply in mid gut.
Migrate to
salivary glands.
5. Become epimastigotes and multiply.
Develop into
infective
metacyclic
trypomastigotes.
HUMAN HOST*
2. Trypomastigotes multiply
in blood. Lymph and in
later stages. In CNS.
* T.b. rhodesiense infects a
wide range of game
animals and domestic
animals.
Fig. 7.3 Transmission and life cycle of T.b. rhodesiense and T.b gambiense.
(From Monica Chesbrough, 1998, District Laboratory Practice in Tropical
Countries, Part One, Cambridge University Press, London.)
Clinical Manifestation
Stage I (Signs & symptoms)
1. Painful trypanosoma chancre
2. Hematogenous and lymphatic dissemination
3. High body temperature
4. Lymphadenopathy discrete
5. Winter bottoms sign (classic), painless enlargement of
lymph node
183
6. Malaise
7. Headache
8. Weight loss
9. Edema
10. Hepatomegally and
11. Tachycardia
Stage II
1. Abnormality in CSF
2. Day time somnolence
3. Tremors
4. Parkinsons disease may appear
5. Hypertonia
6. Congestive heart failure
7. CNS disease develops
8. Coma and death
Diagnosis
Serological test
CSF analysis
Blood film
184
Treatment
1. Pentamidine or
2. Etlornithine or
3. Helarsupron or
4. Trypansamide
These are drugs to be used for treatment of different stages.
For stage I (Normal CSF) T.b. gambie treated with
Suramin or
Eflornithine or
Pentamidine
For stage II
Trypansamide
185
Selectively
clearing
the
bush
and
wooden
areas
186
Review Questions
1. List the common zoonotic diseases and their main mode
of transmission.
2. Which of the Taenia species are most common in
Ethiopia?
a. Taenia solium
b. Taenia saginata
c.
Trypanosomiasis
d. Echinococcus granulosis
3. What are the preventive and control methods for zoonotic
diseases?
187
CHAPTER EIGHT
FOOD-BORNE DISEASES (FOOD
POISONING, FOOD-BORNE
INTOXICATIONS, FOOD-BORNE
INFECTION)
8.1
Learning Objectives
8.2
Introduction
188
would
include
illnesses
caused
by
chemical
growth
in
the
food
before
consumption
189
Clinical Manifestation
Diagnosis
190
Treatment
1. Fluid and electrolyte replacement if fluid loss is significant
particularly in severe cases.
191
8.4
Botulism
Definition
A paralytic disease that begins with cranial nerve involvement
and progresses caudally to involve the extremities.
Infectious agent (Toxic agent)
Toxin produced by Clostridium botulinum (Neurotoxin)
Epidemiology
Occurrence- Worldwide occurrence. Home-canned foods,
particularly vegetables, fruits and less commonly with meat
and fish. Outbreaks have occurred from contamination
through
cans
damaged
after
processing.
Commercial
192
Clinical Manifestations
produces
diplopia,
dysphagia.
Weakness
No fever
Ptosis is frequent.
193
Diagnosis
Appropriate History.
Wound culture
Treatment
1. Hospitalize the patient and monitor closely.
3. Intubation and mechanical ventilation may be needed.
4. Antitoxin administration after hypersensitivity test to horse
serum.
5. Emesis and lavage if short time after ingestion of food to
decrease the toxin.
about
home
canning
and
other
food
194
8.5
Salmonellosis
Definition
A bacterial disease commonly manifested by an acute
enterocolitis.
Infectious agent
Salmonella typhimurium and Salmonella enteritidis are the
two most commonly reported.
Epidemiology:
Occurrence- Worldwide
Reservoir- Domestic and wild animals including poultry,
swine, cattle, rodents and pets (tortoises, dogs, cats and
humans)
and
patients
or
convalescents
are
carriers,
195
disease,
immunosuppressive
treatment
and
malnutrition.
Clinical manifestation
Microscopic leukocytosis.
Diagnosis
Stool, culture
196
Treatment
1. Symptomatic
2. If there is an underlying immunosuppressive disease
(conditions like AIDS, lymphoma, immunosuppressive
treatment), treat the underlying cause.
197
Review Questions
1. What is the basic difference between food poisoning and
food infection?
2. What is the common cause of food infection?
3. How do you prevent and control food poisoning?
198
CHAPTER NINE
NURSING RESPONSIBILITIES IN
THE MANAGEMENT OF
COMMUNICABLE DISEASES
9.1
Learning Objectives
199
200
This
is
especially
important
in
prisons,
201
Appropriate
treatment
of
cases
and
provision
of
chemoprophylaxis.
For sexually transmitted diseases
Sex education
202
Suggest periodical check ups for STDs for bar ladies and
other women at risk.
Use latrines
203
Education
about
home
canning
and
other
food
preservation techniques.
204
Review Questions
1. State the major modes of disease transmission in
Ethiopia.
2. What are the main nursing responsibilities in managing
communicable diseases?
205
GLOSSARY
Albuminuria
Anuria
Biopsy
Bloating
Full
of
liquid
or
gas
and
therefore
Cercariae
Chemoprophylaxis
Chemotherapy
Chronic diarrhea
206
Contact
Cyst
Epididymoorchitis
Fomites
Health
Health education
conducive
to
the
promotion,
Host
to
experimental)
conditions.
207
Accumulation
of
serous
fluid
in
the
scrotum
Immune individual
and/or
cellular
Unapparent
infection
208
skin
tests.
(Synonymous:
asymptomatic,
subclinical,
occult
infection).
Incidence
The
number
of
instances
of
illness
stages
of
parasite
development.
Jaundice
Lymphadenopathy
Lymphadenitis
Melaena
Merozoite
209
Microfilaria
Miracidium
Ciliated
first
swimming
larva
of
must
penetrate
the
Ookinete
Resistance
Source of
infection
210
References
1. Abraham S. Benenson, 1995, Control of Communicable
Diseases Manual, 16th
of
Health,
1997,
Manual
of
National
st
211
Prevention
and Control
Department,
Addis
Ababa, Ethiopia.
13. Monica Cheesbrough, 1998, District Laboratory Practice
in Tropical Countries, Part One; Cambridge University
Press, London.
212